Patients:
A retrospective review of Clinical Centre of Ljubljana Department of Radiology database identified 60 patients who underwent ultrasound-guided percutaneous fine-needle biopsy of solid renal masses between years 2010 and 2011.
There were 27 women and 33 men; mean age of 66 years (ranging from 38 to 88 years).
The patients were referred for biopsy after the masses had been identified on previous imaging.
Procedure:
All biopsies were performed using Toshiba Aplio XV ultrasound machine with a curved array multifrequency transducer (3-6 MHz) and a detachable biopsy guide.
Fig. 2: Curved array multifrequency transducer with a detachable biopsy guide.
Fig. 3: 21 gauge spinal needle used to perform aspiration biopsy.
Each biopsy was performed by two radiologists or an attending radiologist,
with the assistance of a resident.
Initial diagnostic sonography was performed to localize the mass via a trajectory free of overlying bowel,
and color Doppler sonography was used to avoid major blood vessels.
Fig. 4: Localization of the solid renal lesion with a projected trajectory for the guided biopsy free of underlying bowel or major blood vessels.
Biopsy was performed under aseptic conditions.
For local anesthesia,
1% lidocaine was used.
After a skin wheal was raised with a 25-gauge spinal needle,
deeper injection of lidocaine was given down to the renal capsule.
All aspiration biopsies were performed with 20 to 21-gauge spinal needles.
Fig. 5: The whole ultrasound-guided fine-needle aspiration cytology procedure as seen on the ultrasound screen. A radiologist localizes the renal lesion and fixates the transducer so that the projected trajectory of the needle is free of underlying bowel or major blood vessels. Once fixated in place, the other radiologist inserts the needle through the guiding system attached to the transducer, through the soft tissue into the solid renal lesion and aspirates cytologic material.
Fig. 6: Insertion of the spinal needle. One radiologist inserts the needle through the guiding system, while the other is fixating the transducer with the guiding system in a fixed position. Both radiologists observe the passing of the needle through the projected trajectory towards the renal lesion on the screen. Adjustments are made if the needle goes off projected course.
Two specimens were obtained from each patient.
All biopsies were performed without a cytologist present.
Aspirated specimens were sent to a cytologist for an official review.
A specimen was considered diagnostic if there was sufficient tissue to answer the clinical question.